Non-Suicidal Self Injury

This one day workshop on Non-Suicidal Self Injury is based on the following structure.

Part One: Myths and Facts on Self Injury

Part Two: Understanding Why Self-Injury happens

Part Three: Assessing Self Injury Severity

Part Four: Responding to Self-Injury Incidents

The following is an extract of a publication by my colleagues at The Self Injury Project at and The Residential Child Care Project at Cornell University (Whitlock et al., 2016).

“Understanding, detecting, and responding to non-suicidal self-injury (NSSI) presents unique challenges for providers in residential centres. The fact that non-suicidal self-injury can look like a suicidal gesture and is a risk factor for suicidal thought and behaviours makes it a very difficult behaviour to manage. Concerns related to risk of serious harm or death as a result of NSSI have to be balanced assuring an approach that is commensurate with the intent of the behaviour. In the vast majority of NSSI instances, the primary intention is not to end life but to express what feels like an inexpressible emotion and, in some cases, to communicate with others. Responding as though it is a suicide attempt can exacerbate emotions and perceptions that led to the act in the first place and worsen the cycle.

Accurately assessing the risk of unanticipated lethality is important and requires a more complex and nuanced repertoire of action than might be required if all damage to the body is regarded as potentially suicidal in nature and all protocols dictate immediate intervention and hospitalisation. One reason for this complexity is because all acts of NSSI involve harm to oneself in the form of damage to one’s body. The damage may be slight or quite severe and it is usually not apparent through direct observation what the intent might be. While it is understandable to use the most conservative approach in assessing risk, assuming suicidal intent is often counterproductive. Agency staff must manage and reduce risk while at the same time making certain that young people possess safe space for expressing and processing discomfort. In the case of people who self-injure, some of this expression is played out in damage to the body.

The task for agency staff is to accurately a) discern between the intent of the self-injury relative to the presence or absence of desire to end life and b) assess and address the damage inflicted to the body regardless of intent. The questions that most often arise with regard to non-suicidal self-injury, assessment, detection, and response include: What is non-suicidal self-injury and why do people do it? How is it similar and different to suicidal thoughts and behaviours? How do we effectively respond to the underlying desire to feel better and more connected that non-suicidal self-injury indicates while also minimising the potential harm? How should protocols for managing non-suicidal self-injury be similar and different to those we use for managing suicidality?

The goal of this course is to address these questions and to provide information and guidance on how to effectively understand, intervene in, and manage non-suicidal self-injury in residential care and other populations (Whitlock et al., 2016 p R1).”